Payer Utilization Management Consulting Manager/Consultant
: Job Details :

Accenture is a leading global professional services company that helps the worlds leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen servicescreating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 750,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the worlds leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. We are uniquely able to deliver tangible outcomes because of our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song. These capabilities, together with our culture of shared success and commitment to creating 360 value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360 value we create for our clients, each other, our shareholders, partners and communities. Visit us at www.accenture.com.

Strategy & Consulting: We work with C-suite executives, leaders and boards of the worlds leading organizations, helping them reinvent every part of their enterprise to drive greater growth, enhance competitiveness, implement operational improvements, reduce cost, deliver sustainable 360 stakeholder value, and set a new performance frontier for themselves and the industry in which they operate. Our deep industry and functional expertise is supported by proprietary assets and solutions that help organizations transform faster and become more resilient. Underpinned by technology, data, analytics, AI, change management, talent and sustainability capabilities, our Strategy & Consulting services help architect and accelerate all aspects of an organizations total enterprise reinvention.

As a Payer Utilization Management Consulting Manager/Consultant, your primary responsibilities may include:

• Enterprise Function Integration
  • Support the development and implementation of strategies across payer functions (e.g., operations, clinical, finance, and compliance) to enhance utilization management processes.
  • Conduct assessments of client utilization management structures, identifying areas for improvement and alignment with organizational goals.
• Strategic Program Management
  • Manage cross-functional utilization management projects, ensuring timely execution and adherence to quality standards.
  • Create and maintain project plans, timelines, and resource allocation plans.
  • Identify potential risks and support the development of mitigation strategies.
• Regulatory Compliance and Risk Management
  • Ensure clients utilization management practices adhere to healthcare regulations (e.g., CMS, NCQA, HIPAA).
  • Provide support in implementing risk management frameworks and addressing compliance issues.
• Operational Efficiency and Process Improvement
  • Serve as a key point of contact for client stakeholders, building strong relationships and providing guidance on utilization management initiatives.
  • Collaborate with clients to identify process inefficiencies and recommend improvements to reduce costs and enhance service delivery.
  • Leverage data and analytics to support optimization of prior authorization, case management, and appeals workflows.
• Team Leadership and Development
  • Provide guidance and mentorship to junior team members, fostering their professional growth and supporting project delivery.
  • Support internal initiatives to enhance team capabilities and service offerings.
• Data Analytics and Reporting
  • Assist in developing analytics frameworks and dashboards to track utilization management performance and identify improvement opportunities.
  • Present findings and recommendations to client teams, using data to inform decision-making and operational improvements.
• Thought Leadership and Industry Engagement
  • Stay informed about healthcare industry trends, regulatory updates, and advancements in utilization management technology.
  • Contribute to the firms thought leadership through participation in webinars and industry presentations, positioning the firm as a leader in health industry consulting.

Why should I join the Accenture Health team?

• Innovate every day. Be at the forefront of designing and delivering health technology solutions that push boundaries and create new opportunities for our clients.

• Lead with the industrys best. Join an industry-recognized healthcare leader with more than 20,000 global healthcare professionals collaborating to drive enterprise-wide transformational projects on a global scale. Accenture has worked with more than 200 clients to deliver healthcare transformation to meet the diverse needs of patients and members.

• Learn and grow continuously. Harness unmatched training and professional development to help you build and advance your health, consultative and delivery skills. With learning resources, interactive classroom courses, real-life client simulations and ongoing mentoring available when you need it, youll expand your thinking beyond the core Workday implementation.

Qualification

Heres what you need:

• Bachelor's degree in Business Administration, Healthcare Management, Health Policy, or a related field.
• Minimum of 3 years of experience in payer utilization management, health administration, healthcare consulting, or payer operations with a focus on utilization management.
• Minimum of 3 years of experience in healthcare regulations and accreditation requirements.

Bonus points if you have:

• Master's degree preferred.
• Experience working with or leading global teams.
• Thrive in a diverse, fast paced environment.
• An advanced degree in the area of specialization.
• Exceptional problem-solving and analytical skills.
• Excellent communication and presentation abilities.
• Proven ability to plan, organize, and deliver impactful results across multiple projects or initiatives.
• Proven understanding of utilization management operating models, technology enablers, and regulatory requirements.
• Experience executing and achieving specific health utilization and medical cost outcome metrics.
• Experience supporting a payer through a CMS ODAG audit.

Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience. As required by local law, Accenture provides a reasonable range of compensation for roles that may be hired in California, Colorado, District of Columbia, Maryland, New York or Washington as set forth below.

We accept applications on an on-going basis and there is no fixed deadline to apply.

Information on benefits is here.

Role Location Annual Salary Range

California $63,200 to $258,500

Colorado $63,200 to $223,300

District of Columbia $67,300 to $237,800

New York $58,500 to $258,500

Maryland $58,500 to $206,800

Washington $67,300 to $237,800

Requesting an Accommodation

Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired.

If you would like to be considered for employment opportunities with Accenture and have accommodation needs such as for a disability or religious observance, please call us toll free at 1 (877) ###-#### or send us an email or speak with your recruiter.

Equal Employment Opportunity Statement

We believe that no one should be discriminated against because of their differences.All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities.

For details, view a copy of theAccenture Equal Opportunity and Affirmative Action Policy Statement

Accenture is an EEO and Affirmative Action Employer of Females/Minorities/Veterans/Individuals with Disabilities.

Accenture is committed to providing veteran employment opportunities to our service men and women.

Other Employment Statements

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.

Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.

Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process. Further, at Accenture a criminal conviction history is not an absolute bar to employment.

The Company will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Additionally, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.

California requires additional notifications for applicants and employees. If you are a California resident, live in or plan to work from Los Angeles County upon being hired for this position, please click here for additional important information.

Please read Accentures Recruiting and Hiring Statement for more information on how we process your data during the Recruiting and Hiring process.